For Healthcare Providers

PrinterEmail

News

Aetna Policy and Practice Updates

Recent News


Aetna regularly adjusts its clinical, payment and coding policy positions as part of its ongoing policy review processes.  These changes are effective on the dates shown.

Procedure Effective Date Change
Oxygen contents 9/1/2010 Aetna, similar to Medicare, considers oxygen a rented service. When the oxygen delivery systems are rented by the member, oxygen contents are included in the rental rate for the equipment. Effective September 1, 2010, Aetna will no longer pay for oxygen contents in addition to rental payments for oxygen equipment. If the member owns the oxygen equipment, oxygen contents may be payable separately.
Emergency room level of care 11/15/2010 Effective November 15, 2010, payment for facility emergency department services will be based on the level of severity determined by the treating emergency physician. The emergency service evaluation and management (E&M) code billed by the physician will be applied to the corresponding facility bill to determine the appropriate level of payment. Emergency department service evaluation and management codes are represented by the code range of 99281-99285. This policy will not apply to emergency room services that result in inpatient admissions.
Therapeutic radiology simulation-aided field setting; three-dimensional 11/15/2010 Effective November 15, 2010, 77295 will be allowed twice per course of treatment for head and neck diagnoses and once per course of treatment for all other indications. We define a course of radiation therapy treatment as eight (8) weeks, which is in alignment with CMS (Medicare).
Multiple procedure reductions for CT scans, MRIs or ultrasounds 11/15/2010 Effective November 15, 2010, multiple procedure reductions to certain diagnostic imaging services will apply to facility claims. This is an update to an existing payment policy to pay an initial CT scan, MRI or ultrasound at 100 percent, and subsequent scans performed on the same day at 75 percent. This policy is based on the Centers for Medicare and Medicaid Services' (CMS) multiple procedure reduction policy for certain diagnostic imaging procedures.
Procedure codes
requiring
precertification		 Reminder Claims submitted with procedure codes listed on the National Participating Provider Precertification List (NPL) are reviewed to verify the provider's participation status and to determine if a precertification is required for the specific code billed. Failure to contact Aetna for precertification will relieve Aetna or plan sponsors and members from any financial liability for the applicable services. Read the Procedure Code List.